Gastric Tube Cancer Research Articles

Gastric cancer in the reconstructed gastric tube after radical esophagectomy: A single-center experience

Metachronous gastric carcinoma arising in a gastric tube used for esophageal reconstruction has been occasionally encountered in long-term survivors of esophageal cancer. This study investigated 10 cases of gastric tube cancer in order to clarify the characteristics and the outcome of these patients. Four hundred and seventy-one patients underwent a radical esophagectomy at Kyushu University Hospital between 1989 and 2003. There were 10 cases of gastric tube cancer after an esophagectomy. The interval between the esophagectomy and the development of the gastric tube cancer ranged from 1.1 to 7 years. There was no peak for the incidence of gastric tube cancer. In 6 of 10 cases of gastric tube cancer, endoscopic or surgical resection were performed for the treatment; however, chemotherapy was administered to the other 4 cases for several reasons. The prognosis of patients who underwent resection was better than that of the other patients. Frequent endoscopic examinations are therefore important even several years after performing an esophagectomy, since the risk of gastric tube cancer is higher than the risk of a recurrence of esophageal cancer several years after an esophagectomy. Only an early diagnosis permits a less invasive and appropriate approach for the treatment of gastric tube cancer.

Two Cases of Early Carcinoma of a Reconstructed Gastric Tube after Esophagectomy Treated Extendedly with Endoscopic Submucosal Dissection

.Yamaguchi Med J (Yamaguchi Igaku)53:103-107,2004 33) Motoyama S,Mori K,Maruyama K,Sato Y,Hayashi K,Usami S,Suzuki H,Ogawa J:S-1 chemotherapy for cancer of the gastric tube used for esophageal reconstruction following surgery for esophageal cancer(in Japanese with English abstract).Jpn J Cancer Chemother (Gan to Kagaku Ryoho)34:2287-2290,2007 34) Yamasawa K,Shimizu T,Shimosato A,Mihara F,Tokuhara M,Hashimoto M,Saito Y,Endo H,Tamegai Y: Two cases of cancer in the reconstructed gastric tube after resection of esophageal cancer-an analysis of 7 cases in our hospital-(in Japanese with English abstract).Jpn J Gastroenterol(Nippon Shokakibyo Gakkai Zasshi)106: 793-799,2009 35) Koyanagi K,Kanai T,Nakagawa M,Nagase T,Tawara H,Tabuchi S,Koyama I:Endoscopic treatment for metachronous early gastric carcinoma in a reconstructed gastric tube after radical operation of esophageal carcinoma -summary of 29 reported cases-(in Japanese).Prog Dig Endosc 74:24-27,2009 36) Suzumura K,Oh K,Iimuro Y,Yamanaka J,Kuroda N,Hirano T,Okada T,Uyama N,Satake M,Fujimoto J:A case of gastric tube cancer 4 years after esophagectomy for thoracic esophageal cancer treated by endoscopic mucosal resection (in Japanese with English abstract).JJSC (Nihon Gekakei Rengo Gakkaishi)34:582-586,2009 (2010.10.21received;2010.12.13accepted) 88 Shinshu Med J Vol.59 Koide.Suzuki.Akamatsu et al.

Hope from Japan for esophagogastric cancers: esophagectomy and endoscopic submucosal dissection for gastric tube cancer

Westerns surgeons, oncologists, and pathologists are debating: Can the excellent results from early detection and treatment of tumors in the upper gastrointestinal tract reported from Japan and other Asian countries be achieved in the U.S. or Europe? Various reasons have been given to explain the poor survival of patients with gastric and esophageal cancers in the West. Some questions such as what are the effects of the biological, genetic, and molecular differences of cancer genomes between Asian and European ancestry patients remain unanswered. However, these cancer genome differences may only partly explain the better oncological outcomes of Japanese patients. In fact, we in the West should learn from our colleagues in Japan to make better use of screening programs, standardized D2 surgery for gastric cancer, and surveillance after treatment. An example of good practice is the recent 70% 5-year survival rate in advanced stages II and III gastric cancer patients reported by a large-scale multicenter randomized controlled trial in Japan [1, 2]. Therefore, the previous criticism that Japanese studies are limited by the retrospective nature of their analyses and should be considered with caution should now clearly be revised. The prognosis of esophageal carcinoma is dismal. Follow-up data from Cancer Facts and Statistics in the U.S. reveal that esophageal cancer, along with pancreatic and lung cancer, has a very high mortality rate [3]. This suggests that the disease is nearly incurable except when diagnosed at early stage I. Despite the disappointing data, appropriate medical efforts and careful management can not only save some patients but can also improve their quality of life (QOL). Indeed, in support of this statement is the recent report in this journal by Bamba et al. [4]. The authors evaluated the follow-up data of their patients who had undergone esophagectomy to assess whether endoscopic surveillance in these patients is justified. Among 881 patients who underwent esophagectomy for esophageal cancer in Niigata University Medical and Dental Hospital between 1976 and 2006, the authors identified 551 patients in whom a gastric tube was used as an esophageal substitute. Twenty-five patients with 29 gastric tube cancer (GTC) lesions treated between 1989 and 2007 were analyzed retrospectively. The 10-year cumulative incidence rate of GTC was 8.6%. Endoscopic surveillance identified GTC lesions in 95% (17/18) of asymptomatic patients leading to endoscopic submucosal dissection (ESD) in 15 (88%) of them. Overall, pathological examination of the resected specimen after ESD showed a complete (R0) resection in 90% of the GCT cases, whereas it was only 14.3% among 7 patients treated with endoscopic mucosal resection (EMR). No cancer recurrence developed during a median follow-up period of 24 months among the 17 asymptomatic patients. The authors emphasize the need for endoscopic surveillance of patients with a gastric tube after esophagectomy. This approach allows curative treatment with ESD. This study has many important messages useful for dayto-day high-quality clinical practice. Based on a high GTC incidence rate at 10 years (8%), early detection of GTC mostly in asymptomatic patients, and excellent oncological and QOL outcomes after ESD, the authors correctly recommend endoscopic surveillance. However, there are some C. Katsios D. H. Roukos (&) G. Baltogiannis Department of Surgery, University of Ioannina, School of Medicine, 451 10 Ioannina, Greece e-mail: droukos@uoi.gr

Surveillance and treatment for second primary cancer in the gastric tube after radical esophagectomy

Recent improvement in the survival of patients after esophagectomy for esophageal cancer has led to increasing occurrence of second primary cancer in the pulled-up stomach as gastric tube cancer (GTC). However, a treatment strategy for GTC including surveillance has not been established. The aims of this study are to clarify the incidence and clinicopathological characteristics of GTC and to assess the treatment results of endoscopic resection. Twenty-five patients with 29 GTC lesions treated between 1989 and 2007 were analyzed retrospectively. The median interval between esophagectomy and GTC detection was 86 months, and the 10-year cumulative incidence rate of GTC was 8.6%. Of 18 asymptomatic GTCs, 17 lesions (94.4%) were detected by periodic endoscopy and 15 (88.2%) of them were treated endoscopically. Of all 29 GTCs, endoscopic submucosal dissection (ESD) was performed in 10 GTCs with a completely curative resection rate of 90%, which was significantly higher than that of 7 GTCs treated with endoscopic mucosal resection (EMR) (14.3%, P = 0.004). In these 17 GTCs, no cancer recurrence developed during a median follow-up period of 24 months, and the 3-year survival rate was 80.8%. For patients after esophagectomy with gastric pull-up, long-term follow-up including periodic endoscopy is necessary to detect a potentially curable GTC. ESD is a feasible and safe procedure for GTC, with oncologically favorable features.

Endoscopic submucosal dissection allows less-invasive curative resection for gastric tube cancer after esophagectomy – a case series

Detection of early gastric tube cancers (GTCs) has increased with more detailed surveillance endoscopy using indigo carmine dye following esophagectomy. This retrospective study clarified the clinicopathological features and application of endoscopic submucosal dissection (ESD) for GTCs. Data collected for eight GTCs treated by ESD included clinical and pathological features and outcomes following ESD. Overall, eight GTCs were identified in seven (6.3 %) of 112 patients who underwent esophagectomy and gastric tube reconstruction. Almost all lesions were macroscopically type 0-IIa with mucosal to submucosal invasion, and seven GTCs were successfully resected en bloc by ESD. Submucosal invasion to > 500 microm was observed in one case with associated delayed perforation that was treated conservatively. No local recurrences of GTCs were observed. Detailed surveillance endoscopy using indigo carmine dye appears useful for diagnosing early-stage GTC. Furthermore ESD represents a feasible alternative to conventional endoscopic mucosal resection as a minimally invasive therapy for early-stage GTC.

Case Series of Endoscopic Submucosal Dissection for Gastric Tube Cancers After Esophagectomy

Background: Recent remarkable advances in both diagnostic and therapeutic procedures for esophageal carcinoma have contributed to long term survival and potentially increased the number of patients with secondary malignancies. For gastric tube cancer detected at an early stage, minimally invasive treatment such as endoscopic mucosal resection (EMR), or partial resection had been done. Endoscopic submucosal dissection (ESD) for gastric cancer plays an important role in the management of gastric cancer, and recently, ESD has been performed for remnant stomach. However, there are few reports about ESD of gastric tube cancer after esophagectomy. We report here a five case series of ESD for cancers of gastric tube after esophagectomy and evaluate the feasibility and safety of this procedure in such patients. Objective: Our purpose is to retrospectively assess the results of ESD of early gastric cancer in the gastric tube after esophagectomy. Design: Case seriesSetting and Patients: 5 patients with early gastric tube cancer after esophagectomy treated with ESD at Okayama University Hospital from September 2005 to July 2008. ESD procedure: Circumfencial mucosal incision into the mucosa was made with a needle knife and a IT knife after a submucosal injection of glycerol with a small amount of indigocarmine, then, submucosal dissection was carried out by Mucosectome. Results: Of the 5 cases, all lesions were resected completely without complication such as perforation during the procedure. One patient was troubled with severe pneumonia after the procedure and died by chronic pulmonary failure 80 days after ESD. Limitation: Short duration of follow up. Conclusions: In conclusion, ESD of gastric tube cancer can be considered feadible and safe in clinical practice. It is important to detect the lesion at an early stage so as to treat it with minimally invasive therapy such as ESD.

A new operative technique for the resection of gastric tube cancer by means of lifting the anterior chest wall and videoscope-assisted surgery

The prolonged survival of patients receiving surgery for esophageal cancer has led to an increased incidence of adenocarcinoma arising in the gastric tube used for reconstruction (gastric tube cancer). In patients with advanced gastric tube cancer, resection of the gastric tube should be considered, but currently available procedures are very invasive. In patients undergoing curative surgery for gastric tube cancer that has developed after reconstruction through the retrosternal route, the gastric tube is usually resected through a median sternotomy, followed by reconstruction with the colon. However, postoperative complications often occur and treatment outcomes remain poor. We developed a new surgical technique for gastric tube resection without performing a sternotomy in patients with gastric tube cancer who had previously undergone reconstruction through the retrosternal route. Our technique was used to treat two patients. Two Kirschner wires were passed subcutaneously through the anterior chest; the chest was lifted to extend the retrosternal space and secure an adequate surgical field. The stomach was separated from the surrounding tissue under videoscopic guidance. Total resection of the gastric tube was done. The retrosternal space was used to lift the jejunum. Roux-en-Y reconstruction was performed. Neither patient had suture line failure or surgical site infection. Their recovery was uneventful. Our surgical technique has several potential advantages including (i) reduced surgical stress; (ii) the ability to use the retrosternal space for reconstruction after gastric tube resection; and (iii) a reduced risk of serious infections such as osteomyelitis in patients with suture line failure. Our findings require confirmation by additional studies.

Gastric tube cancer: Immunohistochemical study of 10 lesions in six patients

Gastric tube cancer (GTC), defined as carcinoma arising in the reconstructed gastric tube after esophagectomy, has been increasingly reported, but its pathogenesis remains unclear. Therefore, the aim of this study was to examine clinically and pathologically 10 GTCs in six patients. In addition to examination of the clinicopathological features of GTCs, the adjacent gastric tube mucosa was also evaluated immunohistochemically using gastric foveolar markers (MUC5AC and human gastric mucin), pyloric gland markers (MUC6 and M-GGMC-1), and intestinal markers (MUC2 and CD10). All patients were men and three patients had multiple GTCs. All GTCs were located on the middle to lower portion of the gastric tube. Nine GTCs had tubular and/or papillary adenocarcinoma components, and another was signet-ring cell carcinoma. Intestinal metaplasia was found in non-neoplastic mucosa adjacent to nine GTCs. Metaplastic goblet cells adjacent to five GTCs expressed both gastric and intestinal markers, which were similar to the corresponding GTC cells, indicating a close association between the GTCs and metaplastic goblet cells. The other three GTCs expressed only intestinal markers, which may support the suggestion that the intestinal phenotype is expressed later in cancerous development. Pathogenesis of GTCs could be identical to that of ordinary gastric cancer. Cancerous multiplicity associated with esophageal cancer may also play a role in the development of GTCs.

Metachronous cancer of gastroplasty after esophagectomy

We reviewed two cases of adenocarcinoma of the gastric tube used for reconstruction after esophagectomy for cancer. The first case gastric cancer was detected during follow-up by endoscopic examination. Total resection of the gastric tube and reconstruction by Roux-en-Y was performed each time. The patient was alive and disease-free 1 year after surgery. In the second case the tumor was revealed via thoracic pain. Chemotherapy, using carboplatin-5-fluorouracil, was performed because of lung metastasis but the patient died 1 year later. The incidence of gastric tube cancer after esophagectomy has recently increased in conjunction with the lengthening of survival of esophageal cancer patients. The clinical symptoms related to tumors are associated with short-term survival, whereas the cancers detected by routine endoscopy screening have occasional long-term survival. Gastrectomy is proposed for surgical treatment but the operating procedure is complex with a high morbidity rate. Lesions detected at an early stage could be treated by minimally invasive surgery such as endoscopic mucosal resection.

Metachronous gastric cancers after endoscopic resection: how effective is annual endoscopic surveillance?

Endoscopic resection (ER) has been widely accepted in Japan as a less invasive treatment for early gastric cancer, but the incidence of subsequent metachronous gastric cancer (MGC) and the appropriate endoscopic follow-up interval after ER have not been determined as yet. In this study, we investigated the incidence of MGC after ER and assessed our annual endoscopic surveillance program after ER. We studied the clinicopathological features of 633 consecutive ER patients (575 with a single lesion and 58 with synchronous multiple lesions) treated at our institution from 1987 through 2002, after excluding 158 patients who underwent additional surgery due to noncurative ERs, 180 patients whose surveillance periods were less than 1 year, 1 patient with hereditary non-polyposis colorectal cancer, and 1 patient with gastric tube cancer. We defined a second cancer found within 1 year after ER as "synchronous" and a second cancer found after 1 year as "metachronous." First MGCs had an overall incidence of 8.2% (52 out of 633 patients); the annual incidence was constant, and the cumulative 3-year incidence was 5.9%. The average time to the discovery of a first MGC after the initial ER was 3.1 +/- 1.7 years (range, 1-8.6 years). Almost all first MGCs (96.2%, 50 out of 52 lesions) were treated curatively with repeat ER. In order to detect MGC at a stage early enough for a curative repeat ER, an annual endoscopic surveillance program is both practical and effective for post-ER patients.

Treating Gastric Tube Cancer With Distal Gastrectomy Preserving the Gastroepiploic Artery

Total resection of the gastric tube with lymphadenectomy is standard and reliable treatment for gastric tube cancer. However the risk associated with totally removing a gastric tube previously reconstructed through the posterior mediastinal route is significant, given the need to lyse a significant number of adhesions in order to reach the mediastinum. As a less invasive procedure, we used distal gastrectomy to treat superficial gastric tube cancer in 2 patients. The distal gastric tube was mobilized and resected with preservation of the right gastroepiploic artery, and the Roux-en-Y gastrojejunostomy was used for reconstruction. This procedure was curative with less surgical stress.

One-piece endoscopic resection of a gastric tube cancer on the surgical staple line

One-piece endoscopic resection of a gastric tube cancer on the surgical staple line

RESECTION OF CANCER IN THE GASTRIC TUBE USED IN RECONSTRUCTION AFTER RADICAL SURGERY FOR ESOPHAGEAL CANCER-REPORT OF FIVE CASES-

During the recent three decades from 1966 to 1995, we treated 5 patients with gastric tube cancer after a radical esophagectomy for an esophageal cancer. These patients were subjected to a study of age, location of cancer, operative procedure, pathological findings, route of reconstruction at esophagectomy, as well as endoscopic findings, prognosis and the same factors mentioned above at surgery for gastric tube cancer. Mean age was 62 years (range: 57 to 68 at esophagectomy). All cases had undergone an transthoracic esophagectomy. Three cases were reconstructed via retrosternal route, and two cases via posterior mediastinal route at the time of esophagectomy. On the other hand, at the time of operation for gastric tube cancer, a mean age was 68.4 years (range: 63 to 71). Four cancers were located in the antrum, and three cases were performed surgical local resection (SLR). Three cases keep no evidence of disease, but one was dead due to exacerbation of the disease and one died of pneumonia after surgery for the gastric tube cancer. We suggest that SLR is useful technique for early cases, because of difficulty in radical resection for gastric tube cancer. It is important to go through endoscopic examination more than once a year regularly after surgery to detect the disease in an early stage.